A Wellbeing Approach to Challenging Behaviours

Transcription

1 A Wellbeing Approach to Challenging Behaviours Andy

2 Challenging Behaviour The term challenging behaviour was first adopted in 1987 by Blunden and Allen (1987). Culturally, abnormal behaviour(s) of such intensity, frequency or duration that the physical safety of the person or others is placed in serious jeopardy, or behaviour which is likely to seriously limit or deny access to the use of ordinary community facilities". (Emerson,1995) It could be argued that the term has probably become so much a part of the language that it requires a change.

3 Behaviours of Concern The term challenging behaviour should be replaced with behaviour of concern to highlight the ideal response of support staff rather than the challenge they must overcome. (Chan, et al, 2012).

4 Work from a positive framework The emergence of positive psychological approaches to working with people with intellectual disabilities has been partly a focus on constructional approaches (Goldiamond, 1974) to behaviours Focus on strength building and resilience rather than repairing damage.

5 Positive Psychology Positive psychology is concerned with the pleasant life, the engaged life and the meaningful life (Carr 2011, pp2)

6 What is wellbeing? "In essence, stable wellbeing is when individuals have the psychological, social and physical resources they need to meet a particular psychological, social and/or physical challenge. When individuals have more challenges than resources, the see-saw dips, along with their wellbeing, and vice-versa." (Dodge et al, 2012) pp230

7

8 Benefits of Wellbeing Evidence shows that people with positive well-being Live longer Have less coronary heart disease Are more likely to survive cancer Show faster wound healing times Are less likely to succumb to a standard dose of virus

9 Wellbeing and Resilience Wellbeing is a general psychological term, Health is a component of wellbeing Health models tend to focus on building resilience to negate the effects of illness. Psychological resilience is viewed as the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress such as family and relationship problems, serious health problems or workplace and financial stressors. It means "bouncing back" from difficult experiences. (APA)

10

11 Stress and Perceived Control Stress alone is not the main variable but our ability to have control over our daily lives. We have long advocated giving more choice and control and choice to people with intellectual disabilities (Wolfensberger, 1983, Chan et al, 2011). Can we measure perceived control?

12 Lazarus & Folkman 1984 Lazarus & Folkman (1984) described a transactional model of stress emphasizing interaction between an individual and his/her environment. Stress occurs when the demands of stressors outweigh coping responses and there is a clear interaction between environmental and physiological events. Implicit in this model is the cognitive appraisal of threat.

13 Stress and Coping Lazarus & Folkman (1991) linked stress and coping. Coping strategies are a critical variable in this model. In this model individuals with high levels of stress, but with high levels of coping responses do OK.

14 Israel Goldiamond 1974 Strengthening wellbeing is not a new concept. The Psychologist Israel Goldiamond published a seminal ( and one of the longest) articles called. Toward a constructional approach to social Problems: Ethical and constitutional issues raised by applied behavior analysis. Goldiamond focused on antecedents rather than consequences and stressed the need for understanding the complexities of behaviour.

15 Physical Exercise for Carers There are relatively obvious benefits of regular exercise in reducing anxiety (Petruzello, Landers, Hatfield, Kubitz & Salazar, 1991). Exercise can reduce and stabilise cortisol levels over time (McCreadie &McDonnell 2013). McGimsey and Favell (1988) found that when severely aggressive and hyperactive clients were exposed to two daily periods of jogging and strenuous activities there was a systematic reduction in problem behaviour for 8 of the 10 participants to levels considered not a problem or only an occasional problem. Do we consider the physical fitness levels of staff who work with people who challenge?

16 Tools Increase cardiac activity of all types. Focus on everyday health issues that may be unresolved (ie gastric issues, pain, migraine etc). Focus on sleep. Focus on diet. Give people more control over their lives.

17 Tools Use positive language Focus on positive experiences and activity. Avoid focussing on negatives. Model positive engagement with people.

18 Martin Seligman Seligman started his career conducting animal experiments (usually involving electric shocks see learned helplessness). He is now a leading guru in positive psychology. He is one of the most cited psychologists of the 20th Century. This is a major transformation and quite inspirational.

19 Martin Seligman A science of positive subjective experience, positive individual traits, and positive institutions promises to improve quality of life and prevent the pathologies that arise when life is barren and meaningless. (Seligman 2000, pp5)

20 The PERMA Model (Seligman, 2011) Positive emotions Engagement Relationships Meaning Accomplishment \ Achievement.

21 Positive Emotions Feeling good helps us to perform better at work and study It boosts our physical health by strengthening the immune system. Feeling good is contagious. Seeing smiles makes us want to smile. Hearing laughter makes us feel like laughing.

22 Measuring happiness There have been many attempts to measure happiness. Fordyce (1988) developed a simple 2 item measure.

23 Happiness and wellbeing 40% of happiness may be determined by intentional activities, 50% genetic and 10% life circumstances (Lyubomirsky, Sheldon & Schkade, 2005).

24 In general how happy do you feel? 10 point scale ranging from 10= feeling ecstatic, joyous, fantastic to 0= utterly depressed or completely down

25 On average what percentage of the time do you feel happy (or unhappy or neutral?) Scale is a percentage of time

26 Question 1 = 6.9 Question 2 Average score = 54%

27 Engagement Many activities such as running, computer games chess etc motivate us. If you have a job you love, you probably feel this way at work. We are most likely to fulfil our own unique potential when we are engaged in activities that absorb and inspire us.

28 Relationships. Socially supportive relationships within families and close groups are associated with greater wellbeing health and longevity (Diener et al, 2008; Dickerson & Zoccola, 2009).

29 Empathy and Double Empathy Many advocates of Theory of Mind argue that people with autism lack empathy. Due to the fact that they struggle taking the perspective of others and have difficulty reading emotions. Our experience is that many people can understand empathy but are relatively poor at expressing feelings. Empathy is different from sympathy. Milton (2012) referred to a double empathy problem where carers also struggle to empathise with people with autism. Encouraging empathy is a key positive component. "he has feelings like me".

30 We are part of the Problem The vast a majority of challenging situations are inadvertently triggered by supporters (McDonnell, 2010) We are often unaware that we can trigger situations.

31 Give people more control We have long advocated giving more choice and control and choice to people with intellectual disabilities (Wolfensberger, 1983, Chan et al, 2011). Low arousal approaches encourage people to avoid controlling measures. When we take control what are teaching? taking a step back and allowing a person to calm down will ultimately teach a person to self regulate.

32 Tools Self regulation is a critical component of any intervention. John shouts and threatens staff daily ( he used to hit them). John has been observed that he damages more property. John is attempting to regulate his behaviour "I don't want to hit staff because they are OK with me.

33 Meaning This is a slightly deeper concept. We get meaning from the concept of belonging to social groups and networks. Living a meaningful life is, in essence, related to attaching oneself to something larger than oneself. It instills the sense that there is a larger purpose to life, and being a part of it confers meaning. Having such connections with something bigger is also an effective barrier against depression.

34 Achievement\Accomplishment Past successes make us feel more confident and optimistic about future attempts. Goals are a focus of self discovery (see Maslow). Achieving goals helps self esteem and self worth.

35 Conclusions Carers need practice support. Consider mindfulness (see Singh et al, 2008). Good stress management starts with yourself. Reflective practice is the cornerstone of the approach.

36 Further Information Autism and stress, Low arousal approaches Training in behaviour management